As a military-naive civilian, I’m generally opposed to the concept of carpet bombing. Too much potential for collateral damage. Though I suppose that’s the point — to throw everything you’ve got at the problem, unintended consequences be damned.

Again, generally speaking, I’d prefer a more targeted solution. Something focused on the problem at hand and, most importantly, guaranteed to work. But not every problem can be solved that way. In fact, many can’t. And I’m growing a bit fonder of carpet bombing as the best solution to one particularly big problem.

I’ve struggled with binge eating disorder (BED) for a very, very long time. Some years are better than others, but one thing is for certain: the older I get the worse it gets. Worse and worse and worse. Every period of binge eating so much more difficult to squelch than the last. When I spoke recently of wanting to give up, accepting that this is who I am, it was the binge eating in particular that I meant. I have fought for so long — 20 years at least. Probably closer to 25. I have tried a million different solutions. Books, diets, courses, websites, psychotherapy, psychiatric care. And I’m tired.

I told Celeste, my lovely Celeste, so at my last appointment. That I was done. That I was giving up.

She told me no. One more solution… one single thing left to try: medication.

Celeste and I have gone round and round about the idea of medication for several years. Incompatibility of the medication with a potential pregnancy has always been a concern though, and I wasn’t willing to put the brakes on that for any amount of time to give meds a shot.

So a few years later — pregnancy’s a no-go and the binge eating is at full force, so we’re doing it. I’m going to try the medication.

When I think back on all the years of wishing for a magic bullet, a quick cure, it’s remarkable to think how reluctant I’ve been to try what may very well be just that. However, in the interim, I’ve learned a whole lot about the treatment of substance use disorders (substance abuse, addiction) and, in particular, a lot about the concept of medication assisted treatment (MAT). What I’ve learned has been exceptionally pertinent to the way I think about medication for myself in the context of BED now.

MAT itself is somewhat controversial, for a number of reasons not worth discussing here… but what the group I work with has essentially settled on as a guiding principle is that MAT is somewhat of a misnomer as it implies that medication alone can solve what is a very complex problem. We prefer the idea of TAM — treatment assisted with medication. In the case of addiction, it’s using medication to beat back the cravings to such a point that the mind can get to a place capable of recovery. And what that entails, in addition to taking the medication carefully and as prescribed, is a LOT of work, a lot of different kinds of work, and a desperate hope that some bit of that work sticks. Carpet bombing.

Perhaps my situation is not so different. I don’t mean to suggest that BED is on par with or the same as addiction in the traditional sense (although arguments can be made for crossover of elements of BED with elements of substance use disorders as well as obsessive compulsive disorder), but perhaps the treatment paradigm ought to be similar. I don’t want to hang all my hopes on medication and forget about the rest of it. I feel so close to giving up, so tired of trying, if this is to be it — it needs to be it. All in.

Since Celeste wrote my prescription, I’ve spent a lot of time thinking about (and researching) what it would mean for me to be all in. Outcomes for BED treatment are variable and relatively poor — so what to choose? Medication is now on the table, but what else? What else is there that I haven’t tried? The answer, as far as I can tell, is nothing… at least on its own.

So: carpet bombing.

I’m pulling out all the stops and trying it all at once, hoping against hope that something… anything… sticks. My medication finally arrived at noon today and I took my first dose at 12:01, right on time. I’ve ordered an UpToDate-recommended cognitive behavioral therapy (CBT) workbook that I’ll use in conjunction with my routine psychotherapy appointments. And I joined a healthy lifestyles coaching program to focus on the intensive behavioral therapy (IBT) principles espoused by the US Preventive Services Task Force…

If you’re new around here… or just don’t remember clearly every word I’ve ever written (gasp!) and you’re interested in learning a little bit more about my historical battle with BED and body image, you might consider reading these:

Remember when I ranted and raved about how awesome Mindy Kaling is and I told you to add The Mindy Project to your DVR? Did you listen? Are you watching it??? I hope so! Because if not, you’ve missed some seriously funny stuff.

And right now, I’d like… no… LOVE… to talk about this funny little scene right here:

In this scene, Mindy is hanging out at Danny’s and it’s all very cute, but what I really need to bring your attention to is this:

MINDY IS EATING SUGAR CUBES STRAIGHT OUT OF THE BOX!

(See the little box, just next to Mindy’s left hip… that’s the sugar cubes! I’d recognize that box anywhere!)

This scene!

This beautiful, validating scene!!

Seriously, who is watching me at my house?! And how did this get on national television?! And why do I feel so insanely validated right now?!

We’ve discussed binge eating disorder before and it’s very serious and painful and shameful and all of that, of course… but sometimes, when I’m not sitting down in the bottom of that deep dark hole, it’s actually really flipping funny. Because some of the stuff I have eaten when desperate for a binge (yes… this is why food issues parallel the language of addiction…) have been absolutely insane. And I’m not going to lie to you right now, sugar cubes have been it for me before.

But last week, there it was on tv– a gorgeous actress, playing an awesome and lovable doctor on tv, eating sugar cubes straight out of the box. I loved Mindy Kaling before, but this– a whole new level of devotion!

And now that I think about it, these brilliantly funny actresses who are really into food– love them all! Tiny Fey as Liz Lemon in 30 Rock says one time that she’s headed home for a nooner… which is what she calls having pancakes for lunch. Amy Poehler as Leslie Knope in Parks and Rec is a waffle fiend (oh snap, love me some waffles) and when Rebel Wilson as Kimmi in Super Fun Night sees that her man friend has ordered her fries to go along with the champagne, her reaction is priceless! These are the women I can get behind and cheer for, because sometimes food is way more than just food– it can be a nooner, a top three life priority, a mood setter, or even just a little something crispy and sweet to take the edge off a long day. I’m not advocating food abuse, of course, but I do like when it gets represented on tv in a normal way, which is kind of funny, kind of weird, and definitely multi-dimensional in this crazy thin-obsessed culture of ours where to admit you’d rather have the burger than the salad is not the cool thing to do.

I have sugar cubes in my house because they are necessary for real old fashions (i.e. made with bitters and cherries rather than a mix) and my husband is a big old fashion fan. I’ve always thought that they’d be really useful if a stray horse every showed up in our back yard and I needed to lure it to the deck to secure it (it could happen– there’s a lot of Amish around here). Horses do love sugar cubes, right? Why do I feel so sure about this? I don’t know… but it turns out horses and I aren’t the only ones who need a sugar cube every now and again. So does Mindy Kaling as Dr. Mindy Lahiri, and suddenly my secret shame doesn’t feel quite so shameful anymore.

That’s a horse and buggy right across the street from my house– never know when you might need a sugar cube!

While it is true that people in the Midwest tend to be exceptionally friendly, it’s also true that they are quite reserved and that it can be hard to build a relationship with people you only interact with peripherally. As such, it’s taken me quite a long time to get to know the people I work near, but not directly with. But two-and-a-half years later, I’m finally on friendly terms with lots of the people at the clinic and it is good.

After several friendly chats in the bathroom and hallway, I’ve found a lovely friend in one of the well-established and brilliant research scientists in the National Farm Medicine Center named Barbara. Barbara loves to walk (seriously, like 8 miles a day), but recently fractured her foot and is slowly working toward recovery. Likewise, I loved to run, but had tummy troubles that pretty much put a halt to that in recent months. We really bonded over that… our shared loss of beloved physical activities. (And yes, I did tell her all the gory details of my intestinal troubles— this is a good example of that overly quick intimacy I talked about yesterday. Barbara is someone I really like!)

Hmmm… I like where this is going, but I’m going to have to back up just a touch to give you some context. Get ready… I am about to spill my guts.

…

I am a binge eater. I have a binge eating disorder.

You’re probably thinking, right, I know– I was pretty sure you said you were a woman. But no, not just over-eating, not just an inability to resist something delicious. We are talking about a truly life disrupting disorder of ongoing and epic proportions. It’s not a pretty thing and something I have taken great pains to hide for most of my life. (Literally, most of my life… like since I was 8 or 9. This is a kind of big deal to me.)

One of the biggest triggers of my binge eating is, paradoxically, restriction. And when I spend a lot of time restricting what I eat, either in the amount of food or the type of food, I tend to make a wild swing the other way and binge, binge, binge. Sometimes for a day… sometimes for a month.

My second biggest trigger is, kind of pathetically, self-pity. And sometimes I really spiral out of control when it comes to feeling sorry for myself. Boo hoo, poor me, life is rough, and all that.

Unfortunately, all of my gastrointestinal issues and the lengthy process toward diagnosis has led to something of a perfect storm with respect to binge eating.

Following a series of rather unpleasant tests (see that poor me thing? clearly I have a flair for the over-dramatic), I was diagnosed with EXTREME (!) lactose intolerance. (Literally, the diagnosing doc used capital letters and exclamation points in my chart, Dr. Roy showed me… I’ve always been good at taking tests. I blew this one out of the water!) I’ve always known that milk and ice cream were off limits without lots of lactaid, but nothing wrong with a sprinkle of cheese, a pat of butter, a cup of yogurt, right? Wrong. In fact, even my allergy medication contained lactose! What the what?! (Yeah, I’m definitely the one that taught that age-inappropriate phrase to Emily… sorry!)

So, for an entire 1.5 weeks I was crazy careful about lactose– either none whatsoever or precautionary lactaid anytime there was so much of a chance. And my stomach was awesome. AWESOME! For the first time in MONTHS. I went for a couple of runs, my stomach felt great, no emergency trips to the bathroom, no awkwardness.

BUT– I felt super sorry for myself. And I felt like I was being super restrictive.

So. I came back from Mexico and went completely off the rails. The result has not been pretty. Lactose is definitely the culprit.

…

So, back to the story at hand.

I spent the better part of today binging. On lactose-containing things, naturally. Because that’s just how I roll. My stomach hurt, my confidence in my ability to get past this binge was waning, and I was ready to head home and continue the vicious cycle with more food and more self-pity. But, on my way out the door, I bumped in to no other than Barbara and we walked to the parking lot together– chit chatting the whole way.

Barbara was so thrilled that I had a diagnosis and that a simple avoidance of lactose was enough to allow me to run again. She reminded me that running is something I love to do. And she pointed out the gorgeousness of the season and the perfectness of the temperature for running. And she was so right.

So. Right.

So instead of going home and sitting on the couch with a big bowl of lactose-laced anything, I came home, laced up my running shoes, and headed out to pound the pavement for 20 minutes.

It was a brief run, but it was a good start. The temperature was in the upper 40s and perfect and the skies were a bubbly, cloudy gray. I ran past bright red leaves and a sweet puppy that wanted to play. I ran past pumpkins on porches and jammed to Seth’s Road Trip Mix.

Yep, I do love running.

Thank goodness for Barbara and her gentle reminder. For her kind words and genuine interest in my life. She gave me exactly what I need today in such a subtle way. And for that, I am incredibly grateful.

PS: I make jokes… even about serious things. It’s just what I do. But binge eating disorder and any other eating disorder is a serious thing and professional help is required. Don’t worry, I’m getting some. And if you ever feel like you might need help, you should absolutely reach out. For realsies.

"Rachel V. Stankowski considered herself, among other things, a writer. Primarily due to the positive stigmas that accompanied the label, but also because it seemed to excuse some of her more major eccentricities, vanity included."
My brother, also a writer, wrote that about a fictional character. It might have been about me. So I stole it. He's good; maybe I can be too.